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PubMed1988

Fosfomycin versus ampicillin in the treatment of acute pyelonephritis.

In a controlled open study of 38 patients with acute pyelonephritis, treatment with fosfomycin 8 g b.i.d. was compared to treatment with ampicillin 2 g t.i.d., both for one week. The most common pathogen in both groups was Escherichia coli, susceptible to fosfomycin. However, 17% were resistant to ampicillin. The success rate was 44% in the fosfomycin treated group and 28% in the ampicillin group. The difference was not significant (p greater than 0.20). Peak concentrations of fosfomycin in serum were 395 mg/l and in tissue fluid 85 mg/l. Urine concentrations ranged from 6990 to 24,320 mg/l.

Acute Disease↗
PubMed1977

[Characteristics of microbial cultures in bacteriuria and various data on the immunological reaction in children with pyelonephritis].

A study was made of 268 cultures isolated from the urine of 263 children suffering from pyelonephritis. Of the total number of different cultures E. coli constituted 79.3 percent; the percentage of the rest varied from 5.2 to 0.4. Examination of 87 urinocultures of E. coli isolated from sick children with the specific immune response showed that the majority of bacterial signs (urease activity, capacity to produce alpha-hemolysin to utilize saccharose and raffinose, to synthesize colicine) failed to correlate with their pyelopathogenicity. The reference to individual serological groups also failed to serve as a sufficient foundation for the separation of these microbes into individual nephropathogenic or pyelopathogenic groups. In experiments with 3H-glucose labeled bacteria there was revealed a marked adhesive capacity in 94 percent of E. coli strains towards the epithelial cells of the RH strain. A positive radioactive label failed to correlate with the presence in E. coli of common pili and with the bacterial agglutinability with the sera K88, K99, and KH-III. The latter pointed to the presence of a factor of unknown nature in the nephropathogenic E. coli strains imparting adhesive properties to bacteria.

Antibodies, Bacterial↗
PubMed1988

[Diagnosis and therapy of xanthogranulomatous pyelonephritis].

Xanthogranulomatous pyelonephritis (XGP) is a rare, unilateral and multifocal inflammatory response of the kidney against bacterial toxins. In the Department of Urology of the University of Freiburg 6 patients with XGP were observed within 10 years. Despite modern diagnostic procedures differential diagnosis from kidney tumors and other parenchymal kidney diseases remains difficult. Recurrent urinary tract infections, fever, urolithiasis, obstruction and leucocytosis may be indicative of XGP. The diagnosis has to be confirmed by surgical intervention which preferably should preserve functioning renal tissue. The prognosis in general is quite good.

Adolescent↗
PubMed1978

Nonobstructive pyelonephritis initially seen as acute renal failure.

The triad of elevated SGOT and lactic dehydrogenase levels, positive blood and urine cultures, and acute renal failure was noted in a patient with severe pyelonephritis. Bilateral medullary necrosis was found on biopsy and at postmortem examination. These findings may help establish a prompt antemortem diagnosis.

Acute Kidney Injury↗
PubMed1987

What is the role of lipid A in the development of pyelonephritis? A hypothesis.

From the studies of Westenfelder et al. and our own studies of the presence of lipid A antibodies in the upper and lower urinary tract infections, it can be concluded that chronic pyelonephritis is a lipid A induced disease. This hypothesis is based on the distinct statistically different antibody production in upper urinary tract infection in contrast to lower urinary tract infection, the persistence of lipid A in renal tissue, as well as the induction of lipid A nephritis in puppies. These observations should be considered in future studies to proceed in the clarification of these diseases.

Animals↗
PubMed1986

Peripheral lymphocyte subsets in human chronic pyelonephritis.

Comparative study of peripheral blood lymphocyte surface markers in chronic pyelonephritis (CP) and chronic glomerulonephritis (GN) patients, and in normal controls showed no differences between controls and GN patients. In CP patients, a significant absolute increase in B cells, and an absolute decrease in T cells were observed as well as significantly lower and higher percentages of OKT4 and OKT8 cells, respectively, leading to a decrease in the OKT4/OKT8 ratio. Furthermore, the percentage of large granular cells was significantly higher in CP patients, while no differences in TIa cells emerged. The overall picture shown by the CP patients is compatible to a cell-mediated immune (CMI) response defect.

Adolescent↗
PubMed1987

[The state of cellular and humoral factors of nonspecific resistance and immunologic reactivity in chronic pyelonephritis].

Chronic pyelonephritis at the stage of exacerbation is accompanied by the development of combined immunodeficiency characterized by the inhibition of some humoral factors of nonspecific resistance, a decrease in the functional potential of the system of neutrophilic phagocytosis, quantitative deficiency of the circulating pool of thymus-dependent lymphocytes and a decrease in their functional activity combined with disturbance of antibody genesis. Immunomodulating therapy against a background of multiple modality therapy of disease was proposed.

Adjuvants, Immunologic↗
PubMed1986

[Comparative study of the chemotherapeutic effectiveness of mecillinam, ampicillin and their combination in coli bacillary pyelonephritis in rats].

The chemotherapeutic effect of mecillinam and ampicillin was studied comparatively on rats with hematogenic obturation colibacillary pyelonephritis. The antibiotics were administered intragastrically in a dose of 100 mg/kg for 7 days. The treatment was started 24 hours after infection. When the drugs were used in combination their doses were twice as lower. When used alone mecillinam and ampicillin had a significant effect which was practically the same. A marked increase in the therapeutic effect was observed with the use of the antibiotics in combination: sterilization of the tissues of the affected kidney and prevention of development of macroscopic lesions in it in all the animals.

Amdinocillin↗
PubMed1986

[Kidney sonography in childhood in chronic recurring pyelonephritis without a urinary transport disorder].

201 children with healthy kidneys and 61 patients of the paediatric nephrological dispensary with chronically relapsing pyelonephritis without disturbance of the transport of urine were examined sonographically. With the help of an atrophy score was controlled, whether the summation of unspecific parameters is in connection with the length of the kidney. A correlation of the introduced point system with the size of the kidney could be proved. The atrophy score represented shall facilitate the sonographic control of the course of non-obstructive parenchymatous renal diseases.

Adolescent↗
PubMed1986

[Phagocytosis in patients with chronic pyelonephritis].

In 30 patients with a non-obstructive chronic pyelonephritis and two to three clinically manifest urinary tract infections per year as well as in 50 healthy test persons we determined the rate of phagocytosis and the index of phagocytosis of neutrophil granulocytes in absence of serum with Candida albicans and latex particles in double disposition. The mean values of the phagocytosis rate und phagocytosis index of the patients were significantly decreased both for Candida albicans with 40.80% and 1.29 and for latex particles with 67.80% and 2.33 compared with healthy test persons with 54.24% and 1.69 and 86.54% and 3.51, respectively, disturbances of the cell metabolism of the neutrophil granulocytes with an impairment of the function of the cell membrane were discussed as cause of the reduced effect of phagocytosis.

Adult↗
PubMedDate not supplied

[Determination of the urinary secretion of beta 2-microglobulin combined with sequential renal scintigraphy using H123 for the early diagnosis of pyelonephritis in children].

The acute pyelonephritis diagnosis in the infancy is often known very late or it is even underestimate that's why the general adopted criteria normally give no a certainty of the exact centre and the real damage entity. For this reason the authors have adopted a diagnostic protocol, which is based on the association of the urinary excretion dosage of beta 2 microglobulin, with sequential renal scan with Hippuran 123. In cases when the urinary beta 2 microglobulin was increasing, we could check a correspondent alteration of scintigraphic secretory phase. All that has permitted, in whale cases, of establishing with precision and at the right time the centre and the renal damage entity.

Child↗
PubMed1987

Acute pyelonephritis.

Microbial factors that contribute to the virulence of uropathogens, and host factors that predispose to urinary tract infection are summarized in this article. The limitations of methods used to differentiate between upper and lower urinary tract infections are discussed. Recommendations for the treatment of pyelonephritis and its complications are outlined, with an emphasis on the use of safe, potent, renally excreted antimicrobials.

Acute Disease↗
PubMed1978

[Therapeutic studies on two different models of experimental pyelonephritis (author's transl)].

By transurethral instillation of a suspension of a serum resistant E. coli strain (serotype O25:19:12), chronic pyelonephritis is induced in rats, if systemic and local defense mechanisms are impaired by estradiol application. Without hormonal treatment a similar infection can be achieved with a more virulent E. coli strain (serotype O2:1:4). Due to the chronic course of the renal infection in either model, beginning of therapy may be delayed (e.g., 10 days after infection) thus imposing difficult therapeutic conditions on the efficacy of antibiotics to be tested. Evaluation of antibiotics in both models produced differential therapeutic results. In spite of equal MIC's for the applied E. coli strains, gentamicin and particularly cefazolin treatment was less effective in the estradiol treated rats than in those without hormone application. Cefuroxime therapy produced favourable results in either model. The different therapeutic efficacy in both models is to be explained by differences in host resistance to infection. It is suggested that by simultaneans testing of antibiotics in either model, it will be possible to estimate to what extent the therapeutic efficacy of antibiotics depends on the support of intact host defense mechanisms.

Animals↗
PubMed1986

[Pyelo-duodenal fistula complicating pyelonephritis].

The authors report a case of a pyeloduodenal fistula secondary to a gravidic pyelonephritis. The diagnosis was based on intravenous urography. The etiology was probably an unnoticed dysectasia of the pyelo-ureteral junction. The patient recovered following nephrectomy and duodenal suture. The authors conclude with a discussion of the diagnostic and prognostic interest of percutaneous nephrostomy in the management of this rare complaint.

Adult↗
PubMed1979

[Lipoid A, a factor in the pathogenesis of chronic pyelonephritis. Experimental and clinical studies of a lipoid A dependent pathological immune reaction].

Lipid A injected into the temporarily occluded renal pelvis of adult dogs, persisted in the kidney tissue and induced an abacterial interstitial nephritis with positive anti-lipid A titers. This reaction was increased by a single dose of lipid A vaccine, reduced by four consecutive immunisations prior to the lipid A injection and absent in puppies. The presence of IgG, IgM and complement complexes in the kidney was demonstrated by immunofluoroscopy. Lipid A antibody titers were measured by the passive hemolysis test in 349 humans. In two out of 20 healthy adults and 16 out of 18 children with recurrent urinary tract infection anti-lipid A antibodies were present. In contrast, no titers were found in 23 newborn babies. In a group of 156 patients with acute urinary tract infection, 28% revealed positive titers, whereas in a group of 132 patients with recurrent urinary tract infection titers occurred in 81%. Selected from this group of 132 patients 61 suffered from an acute infection of the upper tract. 59 oft these (96%) showed definite titers. There was no difference in the development of anti-lipid A antibodies between men and women and the height of the titers did not correlate with the clinical picture of the disease (acute or chronic). The combination of proteinuria and anti-lipid A antibodies indicates the pressure of reccurrent urinary tract infection or chronic pyelonephritis with about 90% accuracy. The titers are caused by immunogenically active lipid A in the body. Since lipid A has the ability to remain in the renal tissue for a long period of time and thereby to maintain the inflammatory response, long-term antimicrobial prophylaxis (six months) should be given to patients with a high risk of recurrent urinary tract infection.

Animals↗
PubMed1986

[Emphysematous pyelonephritis. Review of the literature apropos of 4 new cases].

Based on four new cases of emphysematous pyelonephritis, the authors review a total or 59 interpretable cases of this rare disease reported in the literature. The general features of this condition are as follows: diabetic women are most frequently affected, the clinical context is generally very serious, the diagnosis is based on X-ray findings, radiating or crescent-shaped radiolucent gas images are observed with a non-functioning kidney on intravenous pyelography. CT scan was performed in two cases and confirmed the presence of air in the renal parenchyma and provided a better evaluation of the extension into the perirenal space. The only effective treatment is nephrectomy which has been able to improve the prognosis of this very serious disease, especially as the characteristic necrosis observed on histology leaves no hope of functional recovery.

Adult↗